Provider Demographics
NPI:1689860033
Name:HENRY, BETSY GRACE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:GRACE
Last Name:HENRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 COVE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6516
Mailing Address - Country:US
Mailing Address - Phone:928-634-0488
Mailing Address - Fax:928-634-0757
Practice Address - Street 1:897 COVE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6516
Practice Address - Country:US
Practice Address - Phone:928-634-0488
Practice Address - Fax:928-634-0757
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0089225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771239OtherAHCCCS
AZAZ 0290670OtherBC/BS
AZ771239OtherAHCCCS